Tumours of the thymic region. Symptomatology, diagnosis, treatment, and prognosis.

Fifty-three patients operated on between 1952 and 1971 were originally diagnosed as having thymoma. Re-examination of the material shows that only half of these tumours were true thymomas. The rest were classified as malignant lymphomas, primary and secondary carcinomas, and a few haemangiomas. Half of the patients had symptoms at the time of diagnosis. However, in half of the asymptomatic cases the tumours had penetrated the capsule. Decisive in prognosis are the macroscopic findings around the capsule. Of 33 patients with infiltration of the capsule, 30 had died at the time of investigation. Twenty-five patients died within two years of operation, Twenty-five patients had thymomas, of which 14 were well defined. Twelve patients with thymomas suffered from myasthenia gravis. The treatment of choice of thymoma is total excision, if necessary enbloc, and if there is penetration of the capsule, radiotherapy should be given. None of the patients with a well-defined thymoma had died from their tumour while only two patients with infiltrating thymomas are still alive, Of eight patients with Hodgkin's disease located in the thymus, six had penetration of the capsule, and of these only one patient is still alive. Two patients with well-defined tumours are both alive. The treatment of localized Hodgkin's disease is excision and irradiation. The prognosis for patients with other malignant tumours was bad, the mean time of survival being less than six months.